naa a22 4500 510744346 CHVBK 20180411083040.0 cr unu---uuuuu 180411e20130501xx s 000 0 eng 10.1007/s12630-013-9890-1 doi (NATIONALLICENCE)springer-10.1007/s12630-013-9890-1 Gabapentin reduces preoperative anxiety and pain catastrophizing in highly anxious patients prior to major surgery: a blinded randomized placebo-controlled trial [Elektronische Daten] [Hance Clarke, Kyle Kirkham, Beverley Orser, Rita Katznelson, Nicholas Mitsakakis, Raynauld Ko, Adam Snyman, Martin Ma, Joel Katz] La gabapentine réduit l'anxiété préopératoire et la catastrophisation de la douleur chez les patients très anxieux avant une chirurgie majeure: une étude randomisée contrôlée par placebo et en aveugle Introduction: Gabapentin is increasingly being used for the treatment of postoperative pain and a variety of psychiatric diseases, including chronic anxiety disorders. Trials have reported mixed results when gabapentin has been administered for the treatment of preoperative anxiety. We tested the hypothesis that gabapentin 1,200mg vs placebo would reduce preoperative anxiety in patients who exhibit moderate to high preoperative anxiety. Methods: A blinded randomized controlled trial was conducted from September 2009 to June 2011 at the Toronto General Hospital. Following ethics approval and informed consent, 50 female patients with a 0-10 numeric rating scale (NRS) anxiety score of greater than or equal to 5/10 consented to receive either gabapentin 1,200mg (n=25) or placebo (n=25) prior to surgery. Randomization was computer generated, and the Investigational Pharmacy was responsible for the blinding and dispensing of medication. All patients and care providers, including physicians, nurses, and study personnel, were blinded to group allocation. Before administering the study medication, baseline anxiety levels were measured using a NRS, the Spielberger State-Trait Anxiety Inventories, the Pain Catastrophizing Scale, and the Pain Anxiety Symptoms Scale-20. Baseline pain intensity (0-10 NRS) and level of sedation (0-10 NRS and Richmond Agitation-Sedation Scale [RASS]) were also measured. Two hours after the administration of gabapentin or placebo (prior to surgery), patients again rated their anxiety, pain, and sedation levels using the same measurement tools as at baseline. The main outcome was a reduction in preoperative anxiety. Results: Forty-four patients (22 treated with gabapentin 1,200mg and 22 treated with placebo) were included in the analysis of the primary outcome. Analysis of covariance in which pre-drug NRS anxiety scores were used as the covariate showed that post-drug preoperative NRS anxiety (Effect size, 1.44; confidence interval [CI] 0.19 to 2.70) and pain catastrophizing (Effect size, 0.43; CI 0.12 to 0.74) scores were significantly lower in the gabapentin group than in the placebo control group, respectively. Post-drug sedation (Effect size, −3.02; CI −4.28 to −1.77) and RASS (Effect size, 0.41; CI 0.12 to 0.71) scores were significantly higher in the gabapentin group than in the placebo group, respectively. Conclusions: Administration of gabapentin 1,200mg prior to surgery reduces preoperative NRS anxiety scores and pain catastrophizing scores and increases sedation prior to entering the operating room. These results suggest that gabapentin 1,200mg may be a treatment option for patients who exhibit high levels of preoperative anxiety and pain catastrophizing; however, the sedative properties of the medication and the possibility of delayed postoperative discharge in the elective ambulatory population need to be considered. Canadian Anesthesiologists' Society, 2013 Clarke Hance Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3EB 317, Acute Pain Research Unit, M5G 2C4, Toronto, ON, Canada aut Kirkham Kyle Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3EB 317, Acute Pain Research Unit, M5G 2C4, Toronto, ON, Canada aut Orser Beverley Department of Anesthesiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada aut Katznelson Rita Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3EB 317, Acute Pain Research Unit, M5G 2C4, Toronto, ON, Canada aut Mitsakakis Nicholas Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3EB 317, Acute Pain Research Unit, M5G 2C4, Toronto, ON, Canada aut Ko Raynauld Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3EB 317, Acute Pain Research Unit, M5G 2C4, Toronto, ON, Canada aut Snyman Adam Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3EB 317, Acute Pain Research Unit, M5G 2C4, Toronto, ON, Canada aut Ma Martin Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3EB 317, Acute Pain Research Unit, M5G 2C4, Toronto, ON, Canada aut Katz Joel Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3EB 317, Acute Pain Research Unit, M5G 2C4, Toronto, ON, Canada aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/5(2013-05-01), 432-443 0832-610X 60:5<432 2013 60 12630 https://doi.org/10.1007/s12630-013-9890-1 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-013-9890-1 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Clarke Hance Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3EB 317, Acute Pain Research Unit, M5G 2C4, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Kirkham Kyle Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3EB 317, Acute Pain Research Unit, M5G 2C4, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Orser Beverley Department of Anesthesiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Katznelson Rita Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3EB 317, Acute Pain Research Unit, M5G 2C4, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Mitsakakis Nicholas Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3EB 317, Acute Pain Research Unit, M5G 2C4, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Ko Raynauld Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3EB 317, Acute Pain Research Unit, M5G 2C4, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Snyman Adam Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3EB 317, Acute Pain Research Unit, M5G 2C4, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Ma Martin Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3EB 317, Acute Pain Research Unit, M5G 2C4, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Katz Joel Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3EB 317, Acute Pain Research Unit, M5G 2C4, Toronto, ON, Canada aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/5(2013-05-01), 432-443 0832-610X 60:5<432 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer